HomeMy WebLinkAbout17872-z lOSM N0. f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T 8E KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
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Permission is hereby granted ta:
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ct premises located at ...~~~.....W.. .~'?'4......s~l~~
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Caunty Tax Map No 1000 Section ..T./ Block Lot No .
pursuant to application dated .r~e2/?:~... 19.~ and approved by the
B u i l d i n g..~~Ijjns~~p--ecto r.
Fee $ !.t&!/~y/
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Rev 6/30/80
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iS~, BOARD OF HEALTH
D 3 SETS OF PLANS
FORM NO.1 SURVEY
FEB 2 4 I~~Q " ! i TOWN OF SOUTHOLD CHECK .
„t.j• BUILDING DEPARTMENT SEPTIC roam
ESLOG pEr^7 TOWN HALL
TON1N GF SOJTNGtp $OUTHOLD, N.Y 11971 NOTIFY
TEL.7G51802 CALL
~r MAIL T0: i~~/ ~G~'Q-'~" Q
Examtncd . ~ ~ • . , 19 V~ 0
~j
Approved ,19°' PermttNo. ~~~7a
Dtsapproved arc
' ~ y
(Bull ~ Inspector)
APPLICATION FOR BUILDING PERM17
Date ..7~.
B~.r~.~...., 15 v
INSTRUCTIONS
a Tlus apphcahon must be completely filled m by typewnter or m ink and submitted to the Building Inspector, with
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree~
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl
capon.
c. The work covered by this apphcatton may not be commenced before issuance of Building Permit.
d. Upon approval of this apphcatton, the Butldmg Inspector will issued a Building Petmtt to the applicant. Such perm[
shall be kept on the premtses available for inspection throughout the work.
e. No butldmg shall be occupied or used to whale or to part for any purpose whatever until a Certificate of Occupant
shall have been granted by the Butldmg Inspector
APPLICATION IS HEREBY MADE to the Butldtng Department for the issuance of a Bwlding Permit pursuant to th
Butldtng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appitcable Laws, Ordinances o
Re_ulahons, for the cons~r~f,',~~>v'il`d~ngs, addthons or alteratrons, or for removal or demolition, as herein descnbed
The applicant agrees to compl wi h all apphcatile-laws, ordinances, butldmg code, housing code, and regulations, and t,
admit authorized iivspectmas-en ~is'~"`Tiutldm4 for necessary inspections.
T~ a~xl ~+!a'1.r, .rt p :cY~,~C.<s.Yu! .
~ ~ ~ ,,a + p t;r,, ~ (Signature of applicant, or name, if a corporation)
nµ 1~ ~ - - 0
ti~-:x CST . z ~n .w~sl,.~1J~4~..Ru~, .G.~~ Pa t~?yt.ll9, t
~t;np+n'~ n ?n+~'+" (Mailing address of applicant)
State wh~eryt`h'e\r ~atppll~t~tt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
. .LI YY l].t~~.4~~.. ^f
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Name of owner of 4 U.~--S....~ U o
v+~~~ ~ «tr` (as on the tax roll or latest deed)
If applicant is a corp$r~ aoi~~~f~luie of duly autlionzed officer
(Name and title of corporate officer)
Builder's License No. ~:LO.' .
Plumber's Ltcense No .
Electrtctan's Ltcense No .
Other Trade's Ltcense No .
1 LOCIlLOn of land on which proposed work `vill be done . .
.
. r< .l ~ .2,eS~ S ~.l.M c.{Te; (S(... U. ~ ~ 7~.~:~.(Vt.?.b ~ ~t.~... .
1{ouse Number 1 Street J
~ Hamlet _~~~z
County Tat Map No 1000 Section ]ttc,k , , Lot :T-7.:.. 3 .
. ~
Subdrvtston ~'d°-~'~~az.. Filed Map No. ~ Lot . y f........ .
(Na ne)
State e~tstmg use and occupancy of premt/ses and intended use .tad occupancy of proposed constntcLOn
a. Ertsttng use and occupancy 7 LG.~,ti~1 !t ~ .
b. Intended use and occupancy • • • • • • • • • • • • • • ~~:~':'t~, , , .
3. Nature of work (check w htch applicable) New Butidmg Addrtton Alteratwn .
Repatr Removal Demohtton OtherlVo~dc~h/.7•l.°f-°<b i
(Descnpuon
4 Esumatcd Cost .....~~.U v...... Fee .
(to be patd on filing thts apphcatton)
5. If dwel[mg, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars .
6. If business, commercral or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, tf any Front Rear Depth .
Hct^ht Number of Stones .
Dtmensrons of same structure wrth alterations or additions Front Rear .
Depth Iietgttt Number of Stones . .
8. Dimensions of entire new cons[ructton Front Rear Depth .
.
Hctglzt Number of Stones .
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
.
11. Zone or use district to whtclr premtses are situated . .
I2. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Hill lot be regraded ................Will excess fill be removed from premtses: Yes 1`
IG. Name of Owner of premtses . ...............Address Phone No............. .
Name of Architect ..............Address ....Phone No.......... .
Name of Contractor ..........................Address ........Phone No............. .
IS.Is this property located with in 300 feet of a tidal wetland? *YES....NO.ir!.
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buddmgs, whether existing or proposed, and. mdtcate all set-back dimensions fro
property lines. Give street and block number or descnptton according to deed, and show street names and mdtcate wheth
tntenor or corner lot.
7~s~~''..~Z,. At 1l~~~#~p~~~
DAT£a J !JR E4'~"µ'~""~
FEE• Ey;
NOTIFY ~
786-f802 i AM 7p 4 PFrf FOR T}IE
FOLLOWING INSPECTIONS:
. 1. FOUNf)ATION 7W0RECtNREp
FOR POURED CONCRETE .
2. ROUGH -FRAMING 1t IM.UNABINQ
3. INSULATION
Q FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SNALL (MEET
THE REQUIREMENTS Of T4iE N.Y.
STATE CONSTRUCT'K)k i ENEIItiY
CODES NOT RESPONSIBLE PDR
DESIGN OR CONSTRUCTION ERROR$
STATE OF irEW YORK, S S
COUNTY OF . .
• • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the apphca~
(Name of individual signing contract)
above named
He uthe.
(Contractor, agent, corporate offrcer, etc.)
of Bard owner or owners, and is duly authon2ed to perform or have performed the card work and to make and Cile th
apphcatton, that all statements contained m flits apphcgGon arc true to the best of lus ],nowledge and 6ehef; and that tl
work will be performed to the manner set forth to the apphcatton fled therewith.
Sworn to before me tfus
Notary Public, ~~i*-! . t! . `~~v.... County
HEIENK.0EY0E .
NOT~IRY PUBLIC, State of New York (Signarure of appltcan
No 4767878, Suttelk CouMy~ 4
Term lxpves March 30,1 u ~